Sustained Transmural Drainage with Plastic Stents After LAMS Removal in Disconnected Pancreatic Duct Syndrome: Evidence from a Systematic Review and Meta-Analysis

BACKGROUND: Disconnected pancreatic duct syndrome (DPDS) is a common sequela of necrotizing pancreatitis, often leading to recurrent peripancreatic fluid collections (PFCs) after transmural drainage. The long-term placement of double-pigtail plastic stents (DPS) following lumen-apposing metal stent (LAMS) removal has been proposed to maintain drainage and prevent recurrence. This study aimed to evaluate the efficacy and safety of DPS maintenance in patients with DPDS. METHODS: A systematic review and meta-analysis was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251167723) . MEDLINE, EMBASE, and SCOPUS were searched for comparative studies including adult patients with DPDS who underwent endoscopic transmural drainage with or without DPS maintenance. We included observational cohorts studies and a randomized clinical trial. The primary outcome was PFC recurrence; secondary outcomes included reintervention and adverse events. RESULTS: Seven studies (n=597) met inclusion criteria. PFC recurrence was significantly lower with DPS maintenance than without (2.9% vs. 22.6%; OR 0.11; 95% CI 0.05-0.26; I²=27%). DPS placement also reduced reintervention rates (5.8% vs. 12.6%; OR 0.28; 95% CI 0.09-0.85; I²=8.2%). Adverse events occurred in 8.25% of cases, mostly asymptomatic stent migration. CONCLUSIONS: Long-term DPS placement after LAMS removal appears to be associated with lower recurrence and need for reintervention in patients with DPDS, without major safety concerns.